Differential diagnosis of axillary lymph nodes: Usefulness of gray-scale and color-power doppler sonography.

PURPOSE: To evaluate and compare the usefulness of gray-scale and color-power Doppler sonography in differentiating benign from malignant axillary lymph nodes, and to find out whether the combined usage of both modalities increased the diagnostic accuracy. MATERIALS AND METHODS: Sixty lymph nodes in 59 patients were evaluated by gray-scale and color-power Doppler sonography. Color-power Doppler evaluation was based on the morphological patterns of vascularity. Spectral wave form analysis was also performed. Sensitivity, specificity, positive and negative predictive values and overall accuracy were calculated for each modality and for the combined usage of both modalities. When two modalities were used in combination a lymph node was accepted to be 'malignant' if it was diagnosed as 'malignant' by either or both of the modalities. RESULTS: Forty lymph nodes were confirmed to be malignant and 20 were benign by histopathologic or sytologic examination or by clinical and sonographic follow-up. Gray-scale and color-power sonography had sensitivities of 92%, 89%; specificities of 70%, 75%; positive predictive values of 86%, 87%; negative predictive values of 82%, 79%; and overall accuracies of 85%, 85% respectively. The combined usage of both modalities yielded a sensitivity of 98%, specificity of 70%, positive predictive value of 87%, negative predictive value of 88%, and an overall accuracy of 88%. CONCLUSION: Gray-scale sonography and color-power Doppler examination have the same overall accuracy for the differentiation of benign from malignant axillary lymph nodes. Spectral wave form analysis was proved to be statistically insignificant. The combined usage of both modalities would decrease the number of false negative cases.